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In a speech at the Health Care Information and Management Systems Society in Florida, Clinton addressed Obamacare—an outgrowth of her 1990s Hillarycare model—cautiously and judiciously. “I would be the first to say that if things aren’t working,” she said, “then we need people of good faith to come together and make evidence-based changes.” Ever the smart politician, Clinton is doing her best to carefully distance herself from the ACA—or at least the parts of it that aren’t working.

The task Clinton outlined needs to begin now—not after the Democrats’ likely defeat in November.

With the midterm elections approaching, every independent observer and many clear-thinking Democrats now recognize that absent significant changes in the legislation, the Democrats will face another “shellacking,” as President Barack Obama called the party’s drubbing in the 2010 midterm elections.

And the ACA is certainly unpopular: According to the latest NBC/Wall Street Journal poll, 49 percent of voters think the health-care law is a bad idea, compared with 35 percent who say it’s a good idea. A Bloomberg poll found a similar result, with 54 percent of Americans saying they’re unhappy with the president’s handling of the issue.

It’s just not enough to call for “fixing it” in generic terms and hope against hope that an unspecified set of changes will trump the Republican call for repeal. House Minority Leader Nancy Pelosi has been a champion of this strategy—a wrongheaded approach to effecting change, notwithstanding Democrats’ belief that this is a more constructive, as well as poll-tested, approach.

Indeed, antipathy to the ACA was almost certainly the reason why Alex Sink, who took the district in her 2010 statewide campaign for governor, lost to Republican David Jolly by just under 2 percent (48.5 percent to 46.6 percent), with a libertarian getting close to 5 percent of the vote. Obamacare is hugely unpopular in Florida, and Jolly smartly capitalized on that anger in his speeches and ads. In late February, only 12 percent of voters wanted to keep the law as is, with 38 percent wanting to repeal it and 29 percent in favor of major changes. I saw the same kind of figures in private polls, adding further evidence that Obamacare was the salient issue in the special election.

The ACA also seems to be pushing down President Obama’s approval rating, which is eight points lower today than it was in March 2010, when the law was passed. In the generic party-preference question, voters preferred Democrats by three points in March 2010. Today, they trail Republicans by one point. Maybe that’s a coincidence, but it sure suggests that the ACA hasn’t helped Democrats’ prospects.

The Democrats need a different approach. And with news that Democratic Senators Begich, Landrieu, Manchin, Heitkamp and Warner along with Independent Angus King have put together a proposal that will soften the impact of the ACA on both businesses and individuals, it is clear that the conversation is moving forward.

Senator Begich said in an interview yesterday, “It’s a tough road, but it’s not a closed road.” I certainly agree, and we need to do more.

It remains to be seen how the leadership will react to their proposal, and it follows that the Democrats, as a party, need to articulate and specify how they will fix the ACA and do everything they can to get these fixes passed to avoid political Armageddon this fall and again in 2016.

There are a number of clear and obvious solutions that are in keeping with the party’s core philosophy but will fundamentally alter its operation and perception.

First, the party can and should defend the Medicaid extension. It’s working, it helps the poor and it is a step forward.

Second, aspects of the ACA are popular and clearly effective. Keeping kids on their parents’ plan until their 26th birthday makes good sense. And any change in the law should necessarily preclude any discrimination based on preexisting conditions.

That being said, if the Democrats are going to minimize their losses in the midterm elections, they need to make fundamental changes to the law. This will involve repealing the dysfunctional health-insurance exchanges, which are simply not working the way they were intended. Signups are at least 2 million people below what was expected, and a majority of states haven’t even set up exchanges. Obama and the Democrats are right to target young people in this final push—they account for a quarter of Obamacare sign-ups, but were expected to be a third or more. We also have no indication of how many of the total 5 million people who have signed up are new enrollees, as opposed to part of the 6 million who reportedly lost their coverage when Obamacare came into effect.

It is not enough for the White House to delay implementation of the employer mandate—it should be eliminated entirely. Let businesses decide how—and if—to extend coverage to their employees now, just as they do with other benefits and just as they have done in the past.

And the Democrats can adopt elements of Oklahoma Sen. Tom Coburn’s plan, which includes some smart fixes and would also demonstrate genuine bipartisanship.

Put bluntly, it’s time to ditch the individual mandate that Americans have health insurance or pay a penalty—the most hotly debated aspect of the law. This week, the White House again delayed the deadline for signing up for some Americans—further evidence of the bill’s slipshod implementation.

Rather than penalize people for not having insurance, “Coburncare” offers incentives for people to get insured. The law could be rewritten in such a way that people could be protected from being dropped by their insurance company as long as they stayed insured. This is a vastly superior approach to what Obamacare requires and makes logical and practical sense.

By leaving the parameters of coverage to the state, Coburncare will take Washington committees out of the process. States, not federal regulators, oversee health care.

Further, Democrats should embrace a reform pushed for years by free-market advocates: allowing Americans to purchase health insurance across state lines, an important component of the new proposal. Plans would become portable as Americans made contracts with private market providers, allowing them to take their plans with them wherever they went or simply to get a better deal in another state.

Obamacare was supposed to be about choice. We can purchase everything else across state lines, so why not health care? With the Internet, the range of choices has only increased. Why not give the private market the chance to effectively operate in a way that will enhance competition, almost certainly drive down prices and increase choice?

Expanding the use of health-savings accounts for enrollees in high-deductible health plans would help to reduce the growth of health-care costs and increase efficiency of the health-care system. These accounts would provide more generous benefits, particularly for low income people, and Democrats should endorse them and work with Republicans to expand their use.

Democrats should also embrace tort reform. Unless something changes, malpractice suits have the capacity to sink our health-care system. Obamacare is supposedly all about helping the average American and the middle class. But as it stands, doctors are afraid of lawsuits and are ordering unnecessary and costly tests as a consequence of the system, not out of a desire to provide better coverage. This is surely not how health care is meant to work. Tort reform would go a long way to fixing this problem.

President Obama needs to embrace these fixes now, not later. He should make it clear that these changes are consistent with Democratic principles—as they are.

Doing so would allow Obama to say that the Republicans, if they refuse to come to table, remain the “party of no.” And he can then justifiably portray the Democrats, whatever the initial failings of Obamacare, as putting forward a clear, coherent and workable health-care plan that continues to extend coverage to poor people, provides relief for those with ongoing infirmities and embraces free-market mechanisms and incentives to lower costs.

Some on the left would say that these changes abandon Democratic core principles. I disagree. The core Democratic principles are to provide as broad coverage as possible, which the Medicaid expansion does, and to promote greater access to care through the free market. Everything I have proposed is in line with those goals.

It is certainly not a Democratic core principle to lose the Senate along with a large amount of additional of seats in the House, let alone to put the 2016 presidential election at risk.

But this is not a question of political tactics or moving away from an unpopular bill. It is about understanding and acknowledging the popular response to the ACA. It’s about making real-world adjustments to policies in order to achieve the same goals.

And yes, it’s about giving the Democratic Party the best chance to prevail in the upcoming elections. If they don’t like these changes, what “fixes” do liberals imagine will be in the offing if, as seems likely, the Republicans take the Senate in 2014 and make major gains in the House?

A GOP triumph in the midterms would deepen the current stalemate and play right into the Republicans’ hands for 2016, allowing the party to run its presidential campaign on … you guessed it … Obamacare. That’s a position the Democrats don’t want to be in. Just ask Hillary Clinton, who clearly sees the danger ahead.